Acetabular dysplasia at the age of 1 year in children with neonatal instability of the hip.

Background and purpose As much as one-third of all total hip arthroplasties in patients younger than 60 years may be a consequence of developmental dysplasia of the hip (DDH). Screening and early treatment of neonatal instability of the hip (NIH) reduces the incidence of DDH. We examined the radiographic outcome at 1 year in children undergoing early treatment for NIH. Subjects and methods All children born in Malmö undergo neonatal screening for NIH, and any child with suspicion of instability is referred to our clinic. We reviewed the 1-year radiographs for infants who were referred from April 2002 through December 2007. Measurements of the acetabular index at 1 year were compared between neonatally dislocated, unstable, and stable hips. Results The incidence of NIH was 7 per 1,000 live births. The referral rate was 15 per 1,000. 82% of those treated were girls. The mean acetabular index was higher in dislocated hips (25.3, 95% CI: 24.6-26.0) than in neonatally stable hips (22.7, 95% CI: 22.3-23.2). Girls had a higher mean acetabular index than boys and left hips had a higher mean acetabular index than right hips, which is in accordance with previous findings. Interpretation Even in children who are diagnosed and treated perinatally, radiographic differences in acetabular shape remain at 1 year. To determine whether this is of clinical importance, longer follow-up will be required

Incidence of early posterior shoulder dislocation in brachial plexus birth palsy

<p>Abstract</p> <p>Background</p> <p>Posterior dislocation of the shoulder in brachial plexus birth palsy during the first year of life is rare but the incidence increases with age. The aim was to calculate the incidence of these lesions in children below one year of age.</p> <p>Methods</p> <p>The incidence of brachial plexus birth lesion and occurrence of posterior shoulder dislocation was calculated based on a prospective follow up of all brachial plexus patients at an age below one in Malmö municipality, Sweden, 2000–2005.</p> <p>Results</p> <p>The incidence of brachial plexus birth palsy was 3.8/1000 living infants and year with a corresponding incidence of posterior shoulder dislocation (history, clinical examination and x-ray) during the first year of 0.28/1000 living infants and year, i.e. 7.3% of all brachial plexus birth palsies.</p> <p>Conclusion</p> <p>All children with a brachial plexus birth lesion (incidence 3.8‰) should be screened, above the assessment of neurological recovery, during the first year of life for posterior dislocation of the shoulder (incidence 0.28‰) since such a condition may occur in 7% of children with a brachial plexus birth lesion.</p

Bone mass in young adults - determinants and fracture prediction.

Bone mass in adolescents and young adults was studied with regard to its age-related change and its determinants. Methodological aspects of bone mass measurements and their ability to predict future fractures were investigated. Bone mineral content (BMC) and bone mineral density (BMD) were assessed by the Single Photon Absorptiometry (SPA) and Dual Energy X-ray Absorptiometry (DXA) techniques. We demonstrate that results, when normative bone mass data are being collected, may depend on whether the study is population-based with randomly selected probands or selected by other means. Participation rate may also influence the outcome. In the same study population, higher BMD levels at several skeletal sites were found by increasing the participation-rate from 61.9 to 83.6%. A limited but significant reduction of forearm cortical BMD in women (<70 years) over the past two decades was found by comparing two samples of healthy women (n=271 and n=155). We conlude that this may be due to life-style changes. In a cross-sectional study of 332 subjects (175 men), age 15-42 years, peak bone mass occurred for both sexes at approximately age 20 in the hip and age 30 in the forearm, lumbar spine and total body. The drop in BMD following peak bone mass was most pronounced in the hip. In this study, 112 subjects (57 men) were studied longitudinally (mean 3.4 years). A high degree of conformity between cross-sectional and longitudinal bone mass data in the description of the age-related change in BMD was found. In a population-based study of 39 girls and 48 boys, childhood weight was found to be predictive of adolescent total body BMC but not total body BMD. This suggests that growth determines the size of the skeleton, whereas the density within that bone envelope is to a greater extent governed by other factors such as physical activity. Familial resemblance in BMD was studied in 40 biological daughter-mother-grandmother triads and 20 biological daughter-mother pairs. A significant correlation was found between age- and maturity-adjusted BMD Z-scores at all sites in the D-M relationship (r=0.25 - 0.39), only in the head for the M-G relationship (r=0.40) and not at all in the D-G relationship. This implies that environmental factors may modify the genetic impact on familial resemblance. In a study of active (n=96) and former (n=25) female fotball players we found higher BMD values in active players when compared with matched controls at several skeletal sites, most pronounced in the hip. The BMD advantage over controls was preserved in former players that had ended their active careers on an average 9.7 years prior to the study. A single bone density measurement of the forearm in a study including 410 women, was found to be predictive of a future fracture on a 25 year perspective. The relative risk (RR) of a fracture with a 1 SD decrease in BMD was 1.33 for all fragility fractures and 1.66 for a hip fracture

Injuries to the nerves associated with fractured forearms in children

Partial and complete injured median and ulnar nerves caused by fractures of the radius and ulna, respectively, in which the symptoms of nervous injury were induced at the time of fracture are reported. In cases with complete loss of nervous function early exploration should be considered at the time of reposition or plating of the fractured bones, or both, and in patients in whom nervous dysfunction occurs after the operation

Estimated effect of secondary screening for hip dislocation

Objectives: To quantify the effect of secondary screening for hip dislocations. Design: Retrospective analysis of hospital files from participants in a prospectively collected nationwide registry. Setting: Child healthcare centres and orthopaedic departments in Sweden. Participants: Of 126 children with hip dislocation diagnosed later than 14 days age in the 2000-2009 birth cohort, 101 had complete data and were included in the study. Interventions: The entire birth cohort was subject to clinical screening for hip instability at 6-8 weeks, 6 months and 10-12 months age. Children diagnosed through this screening were compared with children presenting due to symptoms, which was used as a surrogate variable representing a situation without secondary screening. Main outcome measures: Age at diagnosis and disease severity of late presenting hip dislocations. Results: Children diagnosed through secondary screening were 11 months younger (median: 47 weeks) compared with those presenting with symptoms (p<0.001). Children diagnosed through secondary screening had 11% risk of having a high (severe) dislocation, compared with 38% for those diagnosed due to symptoms; absolute risk reduction 27% (95% CI: 9.7% to 45%), relative risk 0.28 (95% CI: 0.11 to 0.70). Children presenting due to symptoms had OR 5.1 (95% CI: 1.7 to 15) of having a high dislocation, and OR 11 (95% CI: 4.1 to 31) of presenting at age 1 year or older, compared with the secondary screening group. The secondary screening was able to identify half of the children (55%, 95% CI: 45% to 66%) not diagnosed through primary screening. Conclusions: Secondary screening at child healthcare centres may have substantially lowered the age at diagnosis in half of all children with late presenting hip dislocation not diagnosed through primary screening, with the risk of having a high dislocation decreased almost to one-quarter in such cases

Reduced training is associated with increased loss of BMD.

This 8-year controlled, follow-up study in 66 Swedish soccer women evaluated the effect of training and reduced training on BMD. The players who retired during the follow-up lost BMD in the femoral neck, whereas the controls did not. Introduction: Physical activity during adolescence increases BMD, but whether the benefits are retained with reduced activity is controversial. Materials and Methods: At baseline, DXA evaluated BMD in 48 active female soccer players with a mean age of 18.2 ± 4.4 (SD) years, in 18 former female soccer players with a mean age of 43.2 ± 6.2 years and retired for a mean of 9.4 ± 5.3 years, and in 64 age- and sex-matched controls. The soccer women were remeasured after a mean of 8.0 ± 0.3 years, when 35 of the players active at baseline had been retired for a mean of 5.3 ± 1.6 years. Results and Conclusions: The players still active at follow-up had a higher BMD at baseline than the matched controls in the femoral neck (FN; 1.13 ± 0.19 versus 1.00 ± 0.13 g/cm2; p = 0.02). The yearly gain in BMD during follow-up was higher in the active players than in the controls in the leg (0.015 ± 0.006 versus 0.007 ± 0.012 g/cm2, p = 0.04). The soccer players who retired during follow-up had a higher BMD at baseline than the matched controls in the FN (1.13 ± 0.13 versus 1.04 ± 0.13 g/cm2; p = 0.005). The players that retired during follow-up lost BMD, whereas the controls gained BMD during the study period in the FN (−0.007 ± 0.01 versus 0.003 ± 0.02 g/cm2 yearly; p = 0.01). The soccer players already retired at baseline had higher BMD at study start than the matched controls in the leg (1.26 ± 0.09 versus 1.18 ± 0.10 g/cm2; p = 0.01). The former players who were retired at study start lost BMD, whereas the controls gained BMD during the study period in the trochanter (−0.006 ± 0.01 versus 0.004 ± 0.014 g/cm2 yearly; p = 0.01). This study shows that, in girls, intense exercise after puberty is associated with higher accrual of BMD, and decreased physical activity in both the short-term and long-term perspective is associated with higher BMD loss than in controls